Chief of Advanced Heart Failure and Mechanical circulatory support Albquerque, New Mexico, United States
Disclosure(s):
Raymond M. Yau, MD: No relevant disclosure to display
Background: In a predominantly rural state with long transport times and fragmented cardiogenic shock care, a protocolized hub-and-spoke cardiogenic shock program with 24/7 multidisciplinary team was implemented to improve survival and access for rural patients. This study evaluates its impact on survival, referral patterns, and use of mechanical circulatory support.
Methods: Single center, observational Pre and Post cohort study: Heart Hospital of New Mexico
Inclusion: Consecutive adults (≥ 18 years) presenting with or transferred for cardiogenic shock between January 1, 2021 and March 31, 2022 (pre‑implementation) and April 1, 2022 and December 31, 2024 (post‑implementation).
Data from electronic health records, quality databases, and transfer logs capture demographics, co-morbidities, shock center level (1–3), presentation features, etiology, Society for Coronary Angiography and Intervention (SCAI) stage , mechanical circulatory support, mortality at 30 days and 1 year, and length of stay. Limited availability of hemodynamic and clinical variables in the pre‑implementation cohort precluded consistent SCAI staging.
Exclusions: Standard exclusions for non-cardiac limited life expectancy, advanced liver disease, severe neurologic injury, and non-cardiogenic or post-cardiotomy shock.
Limitations: Single‑center pre/post study with potential selection bias, unmeasured confounding, secular trends, and incomplete pre‑implementation hemodynamic and SCAI stage data that may bias era comparisons.
Outcome: 30-day survival improved from 36.5% (19/52) before program implementation to 62.7% (148/236) after implementation, an absolute increase of 26.2% (χ² = 10.93, p < 0.001). Similarly, 1-year survival increased from 32.7% (17/52) to 55.1% (130/236), an absolute improvement of 22.4% (χ² = 7.68, p < 0.001) . Between January 2021 and December 2024, 288 patients with cardiogenic shock were included (52 pre-program, 236 post-program), with similar baseline characteristics and mean ages of 68.6 ± 13.7 and 64.5 ± 15.0 years, respectively (p = 0.07) . Annual cardiogenic shock volume rose from 52 cases pre-program to 126 in 2024 following structured outreach (more than twofold increase, p < 0.001) . Overall survival improved across-SCAI stages from 49.0% in 2022 to 62.1% in 2023 and 69.0% in 2024 (p = 0.0148; ). Mechanical circulatory support utilization declined from 61.5% to 44.5% post-implementation (p = 0.038), reflecting more selective use and earlier intervention. After adjustment for SCAI stage, 30-day survival was similar for transferred and non-transferred patients, supporting equitable outcomes across geography (p = NS). A geospatial, tiered cardiogenic shock network map (levels 1–3, defined by mechanical support, re-vascularization, and multidisciplinary capabilities) illustrates statewide reach and scalability.
Conclusion: Implementation of a 24/7, protocolized cardiogenic shock program in a rural state improved 30‑day and 1‑year survival, expanded rural access without penalizing transferred patients, reduced MCS utilization, and produced year‑over‑year survival gains, supporting this model as scalable for rural cardiogenic shock systems of care.
